What is Closed Rhinoplasty Surgery?

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Rhinoplasty can be broadly classified into open and closed rhinoplasty, which are the two main operative techniques to correct the cosmetic and functional properties of the nose. Many nose surgeons prefer to perform closed rhinoplasty because the procedure is relatively less invasive. Patients often want this option because it leaves no visible scars on the outside.

In case of closed rhinoplasty, surgical access to the nose is achieved through incisions placed inside the nose. This endonasal approach to perform nose surgery has traditionally been more popular, while open rhinoplasty has only gained more popularity in recent years.

Closed Technique

In case of closed rhinoplasty technique, the cosmetic and functional improvements to the nose are made internally through the nostrils. This avoids the need for an incision at the bottom of the nose. The technique may be more appropriate for patients who require limited correction or the ones who are receiving cosmetic nose surgery for the first time.

Changes with closed rhinoplasty technique are usually more subtle and uncomplicated. Results are scarless and more natural looking. Recovery is faster and involves reduced risk of complications as compared to open rhinoplasty. The nose surgeon should have training and experience to perform closed rhinoplasty with precision because the underlying nasal structures will not be openly visible.

Candidacy

Candidates for closed rhinoplasty typically have less severe nasal deformities, tip symmetry, a midline bridge, and no history of significant nasal trauma. Complicated or asymmetric noses are not ideal for this type of nose surgery. Patients may not only seek closed rhinoplasty for aesthetic corrections, but also for improvement of anatomical nasal airway obstruction.

Benefits of Closed Technique

Closed rhinoplasty or endonasal technique has many proponents among facial plastic surgeons, and many patients too prefer this procedure because of its relative simplicity and no external scarring. These proponents put forward the following benefits of closed rhinoplasty:

Reduced need for major surgical dissection

Reduced potential for loss of nasal tip support

Chances of post-surgical edema are decreased

Corresponding reduction in the potential for overall scarring to the nose apart from no external or visible scars

Potential to perform significant improvements in situ

A quicker and more predictable ability to feel the enhancements made to the nose

Potential to make targeted corrections without taking the nose apart

Reduced surgery time

Safer, particularly for older patients

Faster return to a normal appearance

Reduced overall recovery period and less discomfort during recovery

Patients should also note that if they are looking for substantive changes to the nose, they may require open rhinoplasty. It is paramount to have reasonable expectations from the closed technique.

Nose cosmetic surgery, clinically known as rhinoplasty, is designed to improve the proportion and appearance of the nose and enhance facial balance.

The procedure may also be used to correct breathing issues or abnormalities occurring due to birth defects or trauma. Rhinoplasty can be performed using various techniques, depending on the patient’s unique anatomical and cosmetic needs.

The nose surgeon will carefully determine the patient’s candidacy for rhinoplasty and create a customized surgical plan using the most appropriate technique. Board certified facial plastic surgeon Dr. Trang Vo-Nguyen (Dr. V) provides rhinoplasty to patients in Chantilly, Northern Virginia, Loudoun County, Fairfax, Prince William, Fauquier, Arlington, Middleburg, Leesburg, Manassas, Warrenton, and other cities in this part of the state.

Improvements with Nose Surgery

Cosmetic nose surgery can enlarge or reduce nasal structures with the use of cartilage grafted from the septum or other areas of the body. If the nasal septum is deviated, the surgeon can straighten it and reduce the projections inside the nose to facilitate breathing.

Once the underlying nasal structure is sculpted to the desired shape, the nasal skin will be re-draped and incisions closed. Rhinoplasty can be used to increase or decrease the overall size of the nose. Nose tip can be refined, bumps on the nasal bridge can be removed, and flared nostrils can be reshaped as needed.

In case of trauma, a major post-traumatic nose surgery can be performed. Reconstructive rhinoplasty may be performed to correct birth defects or deformities caused due to skin cancer, other illnesses, or trauma. Ethnic rhinoplasty is a procedure to specifically improve the nasal characteristics of African American, Latin American, Asian, or Middle Eastern patients.

Open and Closed Rhinoplasty

Open and closed rhinoplasty are the two broad classifications of cosmetic nose surgery. Major nose reshaping or restructuring procedures will require open rhinoplasty. In this case, the surgeon will make the incisions in the columella, which is the vertical strip of skin dividing the nostrils. Through the incision, the surgeon will lift off the underlying nasal structures to view and correct the nasal anatomy.

In case of minor nose reshaping, the surgeon can perform closed rhinoplasty. This involves incisions within the nose only. The nasal skin is then separated from the cartilage and bone, which constitute its supporting framework. Once exposed, cartilage and bone can be reshaped, removed, rearranged or augmented to create the desired new results. Closed rhinoplasty will leave no scarring on the outside.

Other Types of Rhinoplasty

Revision rhinoplasty or secondary rhinoplasty is a procedure designed to correct problems that have remained or emerged after a previous nose surgery. Revision procedures are typically more complex and should only be performed by an experienced facial plastic surgeon.

Filler rhinoplasty is a non-surgical nose reshaping procedure that involves the use of dermal filler injections. These fillers can smooth out the depressions and sharp angles or correct the angle of the nasal tip to improve symmetry.

Estimated Recovery Period

Most patients will be able to return to work or resume their normal activities in about one week after chin surgery. However, they must refrain from strenuous activity and exercises for a few weeks to allow the healing to be completed safely. Bruising will subside from the second week, and may be entire gone in about 10 to 14 days.

Minor swelling will linger on for several weeks, but the patient can hide it with makeup and continue with their social and professional life. Results will be visible in about two weeks as the bruising and swelling is significantly resolved. Full results will, however, establish over a few months as the swelling goes away complete.

Initial Recovery Experience

For the first couple of days, the patient may have some bloody drainage from the mouth. If the surgery was performed through the mouth, this is a normal occurrence. Minor swelling in the face and neck is initially expected. The patient should sleep with their head elevated for the first few days to control swelling. This can be accomplished with the help of several pillows under the head or sleeping in a recliner chair for the first two to three days.

Ice therapy can be used in the first one or two days to help with the swelling around the chin and lips. The patient is encourage to perform short walks at home in the first week or perform light activities to promote blood flow. However, lifting of heavy weights and vigorous exercises should be avoided for about one month.

Eating during Recovery

The meals on the first day after the surgery should light in order to minimize chewing. The lower lip is likely to have numbness for several days after the procedure. Therefore, care should be taken to ensure that excessively hot food is not eaten. Eating can be slightly difficult at first because the muscle activity of the lips will be temporarily altered.

But it will return to normalcy over time. If a chin implant has been placed through the mouth, the patient should take care to ensure that the stitches inside the lower lip are not damaged. Experienced facial plastic surgeon Dr. V receives patients from Chantilly, Northern Virginia, Loudoun County, Fairfax, Prince William, Fauquier, Arlington, Middleburg, Leesburg, Manassas, Warrenton, and nearby areas for mentoplasty.

Other Instructions

Bending over and putting pressure on the chin area with the hand should be avoided for six weeks. The patient can brush the teeth normally, but care should be taken in the incision area if implants are placed through the mouth. Grinning, smiling, and excessive facial movements should be avoided for two to three weeks.

Rhinoplasty or nose surgery can primarily be performed using open or closed surgical techniques. Depending on the patient’s unique cosmetic requirements to improve the size or shape of the nose and their current nose condition, the surgeon will recommend the appropriate rhinoplasty technique.

Benefits of Open Rhinoplasty

If the patient requires substantive changes in the nose shape or size, or a reconstructive or post-traumatic rhinoplasty is needed, an open rhinoplasty technique may work best. This procedure will allow the surgeon access to a greater part of the nose. Many times it may also help them to make minor adjustments to the nasal tip.

The surgeon will make a small incision in the columella, which is the vertical tissue between the two nostrils. The columella becomes the access point to open the nasal skin and clearly view the underlying structures. With more precise visualization of the structures, the surgeon may be able to create more effective cosmetic results.

Although open rhinoplasty technique can yield excellent outcomes, but it is important to ensure that the operating surgeon is fully trained in facial plastic surgery procedures to have a detailed understanding of the underlying anatomy. Wider dissections and re-establishing support with sutures and grafts means that an expert surgeon is required to achieve the desired results with open rhinoplasty.

Procedures Involving Open Technique

Reduction Rhinoplasty

To create a nose more proportionate to other facial features, the surgeon may perform reduction rhinoplasty using open technique. The procedure can address flared nostrils, elongated nasal tip, and bumps on the nose bridge. Small amounts of cartilage and bone may be removed to create the desired results. Alar base reduction procedure may be performed to reduce the size of the nostrils.

Augmentation Rhinoplasty

This procedure, involving open rhinoplasty technique, will require the surgeon to perform tissue or bone grafting to build up the nasal tip or bridge. Cartilage from the nasal septum may be used for the grafting. Synthetic implants may also be used sometimes to augment the size of the nose to improve overall facial balance.

Post-Traumatic Rhinoplasty

If the patient has sustained a nasal injury, they may require post-traumatic rhinoplasty, which would involve the open technique. The procedure can address both functionality and appearance. The procedure can help to correct the nasal septum and straighten the nose. The surgeon may have to re-fracture the nose and reset it to build the desired nose.

Reconstructive Rhinoplasty

If the patient has lost all or part of their nose due to skin cancer or an accident, they may need reconstructive rhinoplasty. The surgeon will use the open technique to rebuild the nose with the help of flap techniques, skin grafts and other advanced methods. Multiple surgeries may have to be performed over several months.

Experienced facial plastic surgeon Dr. V receives patients from Chantilly, Northern Virginia, Loudoun County, Fairfax, Prince William, Fauquier, Arlington, Middleburg, Leesburg, Manassas, Warrenton, and other neighborhoods and so on across the landscape in this part of the state for open rhinoplasty and various other surgeries.

Upper eyelid surgery or blepharoplasty is a key procedure to correct the condition of droopy eyelids. It usually involves removal of excess upper lid skin and fat, and tightening of the underlying muscles to produce a more alert, youthful eye appearance. However, sometimes the surgery may be required to also correct the underlying condition of ptosis.

Functional Eyelid Surgery

Upper eyelid ptosis surgery is slightly different from cosmetic eye lift procedures. Ptosis surgery is designed to lift the position of the upper lid margin by tightening the muscle and tendon that are normally involved in elevating it. Cosmetic blepharoplasty may be used when the heaviness of the excessive skin is weighing down the upper lid, so it can be corrected with removal of excess skin.

However, when the ptosis or upper lid droopiness occurs due to aging or medical reasons, a functional eyelid surgery will be required. The procedure can be performed at a surgical center on an outpatient basis, and it is usually completed in about one to three hours. Complete recovery and final results will be established in about four to six weeks after the surgery.

Procedure to Correct Muscular Ptosis

Muscular ptosis may occur in children or may be acquired later in life as the muscle tends to sag due to aging or other factors. If the levator muscle has some strength remaining, the condition can be corrected by performed levator resection or tightening of the levator muscle. When the muscle is first tightened, the patient may not be able to blink normally. However, the condition will improve over time and normal closing of the eye can be performed.

If the levator muscle is extremely weak, the muscle tightening will not be enough to raise the lid sufficiently. In such case, a frontalis suspension is required. In this procedure, small strands will be placed between the eyelid and eyebrows. The strands are then tightened to raise the lid. This procedure will allow the patient to comfortably raise and close the eyelid as well as raise and lower the brows.

In case of adults, a frontalis suspension is performed using a strand of solid silicone, but in case of children, fibrous tissue is used so that they can easily close the eyelids after the procedure. Experienced facial plastic surgeon Dr. V receives patients from Chantilly, Northern Virginia, Loudoun County, Fairfax, Prince William, Fauquier, Arlington, Middleburg, Leesburg, Manassas, Warrenton, and nearby areas for drooping eyelid procedures.

Recovery

Following the surgery, the eyelid will have some swelling, and the vision will be blurry for some time. The patient should keep the head in elevated position and use cold compresses frequently in the first two or three days to mitigate the swelling. The treated eyelid will initially appear stiffer than normal, and the eye will feel dry. The surgeon will prescribe a lubricating ointment to provide relief from these temporary side effects.

Eyelid drooping typically occurs in the upper eyelid, and may affect one or both eyelids. If left untreated, it can adversely affect the vision. In many cases, the condition of ptosis or eyelid drooping will be barely noticeable, or will come and go intermittently. Therefore, it is critical to know the symptoms, and seek medical attention in a timely manner.

Common Symptoms

If the condition of sagging eyelid occurs only one side (unilateral), it becomes easier to notice because of the obvious difference between the eyes. Congenital ptosis will be present at birth, and the symptoms may be barely noticeable in the beginning. Even among adults, sometimes the symptoms are more or less prominent, depending on the severity of the condition.

The most common sign of a drooping eyelid is that the person will experience a limited field of vision or partial vision obstruction. Over time, this condition may also produce excess tears in the affected eye. The patient suffering from ptosis will often find it difficult to keep their eye open. They may typically tilt their head back or repeatedly raise their eyebrows in an effort to lift the droopy eyelid.

When the patient is tired, the drooping usually becomes more conspicuous because the muscles fatigue. While many patients will have watery eyes due to ptosis, in some cases, the affected eye may become extremely dry. The patient’s face also looks tired or weary.

Some patients complain of aching around the eyes, which can also make them appear tired. In more severe cases, the patient may tend to tilt their head back at all times when speaking, even while having a normal conversation. The treatment provider will also assess symptoms such as migraines or other issues that may indicate any underlying conditions as the cause of eyelid drooping.

In most severe forms of ptosis, the vision can be completely obstructed because the upper eyelid sags so much that it tends to cover the pupil. Experienced facial plastic surgeon Dr. V receives patients from Chantilly, Northern Virginia, Loudoun County, Fairfax, Prince William, Fauquier, Arlington, Middleburg, Leesburg, Manassas, Warrenton, and nearby areas for ptosis treatments.

Dry Eye Symptoms

If the one or both eyes constantly feel dry, sandy or gritty, the patient may be suffering from dry eye, which could be caused due to drooping eyelids. Other symptoms include sore, irritated or red eyes, and difficult in wearing contact lenses. Sometimes the eyes may become watery due to dry eyes because the body produces excessive tears in response to the dryness.

Watery Eye Symptoms

Constantly watering eyes may occur due to drooping eyelids. While the body naturally produces tears to keep the eyes lubricated, but too many tears may be the result of conditions such as ptosis. A medical professional will determine the cause and recommend appropriate treatment to address the symptoms.

Eyelid drooping may occur due to various possible causes ranging from natural causes to medical conditions and trauma. A medical professional will be able to determine the cause of ptosis, and advise appropriate treatment.

Natural Causes

Eyelid drooping can affect anyone at any age, but it is more common among older people because of the natural aging process. Lifting of the eyelid is performed by a tendon that is attached to the levator muscle. As a person ages, this muscle can sag, and as a result the eyelid will tend to droop. However, ptosis is not just caused due to aging, and sometimes even babies and children can be affected by this condition.

Precise cause of ptosis may remain unknown in some cases, while in some cases it may occur due to trauma or neurological problems. In case of congenital eyelid drooping, the key cause is that the levator muscle fails to develop well, impact the patient’s ability to open the eye. Children suffering from ptosis are at a risk of developing amblyopia, commonly known as lazy eye.

Ptosis in One or Both Eyelids

If the eyelid drooping occurs in both eyelids, the chances of an underlying medical condition are higher. But if only one of the eyelids is drooping, it may be due to a nerve injury or temporary swelling or inflammation. In rare cases, routine cataract or LASIK surgery may be the cause of development of ptosis, if the tendon or muscle gets overstretched.

Serious Medical Causes

Serious medical conditions such as brain tumor, stroke, neurological disorders or cancer of the nerves may sometimes causes eyelid drooping.

Myasthenia Gravis

Droopy eyelids can be an early symptom of myasthenia gravis, a rare disorder that affects the ways muscles respond to nerves. This condition can cause progressive muscle weakness, extending not just to eyelids but also to other part of the face and body.

Muscle Diseases

A hereditary muscle disease known as oculopharyngeal muscular dystrophy may affect eye motion. In younger people, ptosis may occur due to a group of muscle illnesses known as progressive external ophthalmoplegia. These illnesses can cause ptosis in both eyes and problems in eye movement.

Nerve Problems

Any condition that causes injury to the brain or its cranial nerves may sometimes cause ptosis. This can happen because the eye muscle movement is controlled by the nerves that come from the brain.

Stroke, brain tumor, brain aneurysm, or nerve damage related to long-term diabetes are some of the conditions that can contribute to ptosis. In a few cases, eyelid drooping may occur due to an infection of a tumor of the eyelid, or a tumor inside the eye socket.

Pathologic Eyelid Drooping

Ptosis, or pathologic eyelid drooping may occur due to age, genetics, trauma or a medical disorder. In some cases, the lid may droop only a little, while in other cases, it may cover the entire pupil. For some patients, ptosis can obstruct the vision, or even block the complete normal vision. Ptosis may occur in both children and adults.

Ptosis condition may affect only one eyelid, which is called unilateral ptosis, or both eyelids, which is known as bilateral ptosis. In some patients, the condition may be permanent, while in others may be recur intermittently. If the condition is present at birth, it is known as congenital ptosis.

Timely Intervention

In most cases, it is possible to resolve the condition of ptosis through medical intervention or surgery. In some cases, the condition may also resolve naturally over time. Sometimes the condition may develop gradually over the years. Therefore, timely treatment is important so that the problem does not worsen.

Sometimes ptosis is only an isolated problem that will alter a patient’s facial appearance, without impacting their health or vision. In such cases, treatment may help to restore an attractive facial appearance and remove the old or tired look from the eyes.

Patients should note that sometime ptosis can be a warning sign of a more serious health condition. Such health condition may be affecting the brain, muscles, nerves or eye socket. If the ptosis develops fairly quickly, it is more likely to indicate a serious medical problem. Timely medical attention must be sought in such cases to diagnose and treat the condition.

Ptosis in Children

Congenital ptosis in children is often caused due to poor development of the levator muscle that performs the function of lifting the eyelid. This condition generally does not improve on its own over time. Therefore, the child may require treatment to ensure that their vision develops normally.

The most serious problem associated with ptosis in children is amblyopia or lazy eye. This causes poor vision in an eye that did not develop normal sight during early childhood. If the condition is not treated early, it may result in permanent loss of vision later in life. The condition may occur if the eyelid is severely droopy and blocking the child’s vision. Ptosis may also hide crossed or misaligned eyes, which can lead to amblyopia.

Prevention

While there is no specific way to prevent ptosis or eyelid drooping, it is important to know the symptoms and visit a medical professional when droopiness is noticed. Experienced facial plastic surgeon Dr. V receives patients from Chantilly, Northern Virginia, Loudoun County, Fairfax, Prince William, Fauquier, Arlington, Middleburg, Leesburg, Manassas, Warrenton, and other cities in the vicinity for the corrective surgery of droopy eyelids.

Volbella is the latest addition to the Juvederm family of hyaluronic acid based dermal fillers from Allergan, Inc. Juvederm Volbella received the FDA’s approval on June 1st, 2016. Unlike most other facial cosmetic fillers, Volbella is primarily designed to enhance lip volume, improve lip contour, and help smooth the pesky upper lip lines that are a common concern for many people.

Volbella attracts less moisture after the injectable gel is administered, resulting in much reduced bruising and swelling. Furthermore, the results are longer lasting that most other facial soft tissue fillers at 12 to 14 months. Vobella’s unique Vycross molecular cross-linking technology increases its sustainability and slows down the degradation

Areas of Correction

Juvederm Volbella filler gel can boost the lip volume, mitigate upper and lower lip lines, which are also called smoker’s lines, improve superficial smile lines, and also treat the oral commissure to help with downward turn of the mouth. Some patients may require more pervasive facial anti-aging results in different areas of the face.

In such cases, Volbella treatment may be combined with Juvederm Voluma or Juvederm Ultra, depending on the extent of volume loss to be corrected. Volbella is highly effective for the mouth area, and helps improve the more superficially etched in lines that are in a static condition. When Volbella treatment is combined with Botox or other dermal fillers from Allergan, the patient may also be eligible for attractive incentives from the manufacturer.

Post-Treatment Care

One of the advantages with Volbella is that the post-treatment downtime involved is considerably lower than other injectable fillers. This is possible because Volbella attracts less water than any other dermal filler, which minimizes the swelling and bruising.

Initial mild discomfort can be addressed with an ice pack, which will also help to lessen swelling. The patient may be required to visit the treatment provider for a follow-up appointment in two weeks.

Candidacy

People who are unhappy with the loss of lip volume or the appearance of upper lip lines or downward turned mouth may be the right candidates for Juvederm Volbella. The dermal filler is based on hyaluronic acid, which is fully biocompatible and requires no prior skin allergy tests to determine candidacy.

Comparison with Juvederm Ultra and Restylane

Volbella is longer lasting than Juvederm and Restylane because its mixture of high and low molecular weight in the hyaluronic acid makeup. Volbella is easier to mold, which gives it a higher degree of range in the balance of cohesiveness and elasticity.

It is smoother and easier to inject because it is less viscous, and causes less swelling and less reactionary inflammation because it draws less water than Juvederm Ultra and Restylane. Dr. V receives patients from Chantilly, Northern Virginia, Loudoun County, Fairfax, Prince William, Fauquier, Arlington, Middleburg, Leesburg, Manassas, Warrenton, and nearby areas for Volbella filler treatment.

Facial profile balancing will typically involve improvement in the size and shape of the nose, chin, and cheeks. Chin and nose augmentation or reduction can be achieved through both surgical and non-surgical procedures. Similarly, adding volume to the cheeks is possible through implant surgery as well as certain dermal filler injections.

Nose or Chin Reduction

With rhinoplasty surgery procedure, it is possible to refine the nasal tip, narrow the nostrils span, change the angle between the nose and the upper lip, or mitigate the overall size of the nose by surgically reducing the bone and cartilage. This may be necessary when the chin appears more prominent due to an oversized nose.

Conversely, if the chin is oversized, which makes the nose appear smaller it may require the cosmetic surgeon to perform chin reduction surgery. The surgeon will carefully reduce some portion of the bone and tissue from the chin area, or may perform chin liposuction, if excess fatty tissue is present in the area.

It is difficult to perform the nose and chin reduction procedures with non-surgical procedures. However, if only minor imbalance exists in the facial profile, the treatment provider may use dermal filler injections to increase the size of the nose or chin to improve the balance and proportion between the nose and the chin.

Nose or Chin Augmentation

If the nose or chin is naturally smaller sized, causing facial profile imbalance, it can be effectively corrected with both surgical and non-surgical procedures. Nose or chin implant surgery may be used to add bulk to the undermined area and bring it in balance with other facial features.

Alternatively, dermal filler injections such as Juvederm, Restylane or Radiesse may be applied to add volume to the nose or chin tissue and create a subtle lift. This is a simple, in-office procedure involving no incisions or general anesthesia, and no significant discomfort or downtime.

Implant surgery carries the risk of infection, which is almost entirely avoided with FDA approved cosmetic fillers administered by a skilled provider. Non-surgical chin or nose augmentation is more suited for busy moms and working people who usually want a procedure involving minimal downtime.

Cheek Augmentation

If the cheeks have lost volume due to aging or other factors, it can create a sunken look in the mid-face and compromise the overall facial profile balance. Cheek implant surgery may be recommended in such cases.

But if the patient wants to avoid surgery, they may choose non-surgical options such as Juvederm Voluma or Sculptra Aesthetic injectable fillers. These injectable treatments will instantly volumize the cheeks and create a smoother and even looking face.